Five-Year Treatment Outcomes of Resident-Performed Ahmed Valve Implantation for Glaucoma.

PRCIS: Ahmed Glaucoma valve implantation by residents showed similar complications, success, and failure rates, regardless of their level of expertise. Training programs must encourage ophthalmologists to perform this surgery to enhance competence in their future practices. PURPOSE: To describe outcomes of resident-performed Ahmed Valve implantation over a 5-year period. METHODS: In this cross-sectional observational study we retrospectively reviewed the medical records of patients who underwent resident-performed Ahmed Glaucoma Valve implantation over a 5-year period. The main outcomes were the number of surgeries performed by first, second, and third-year residents, intraoperative and postoperative complications, and the association of level of training with outcomes and complications. RESULTS: 160 eyes were included, with a mean age of 53.8±15.4 years, 63% were men. The most frequent type of glaucoma was neovascular glaucoma (67.5%). Mean follow-up was 23.2±19.6 months. Residents of higher years performed more surgeries and no relationship was found between the surgeon's level of training and type of glaucoma operated on. After the surgical procedure, significant changes in best-corrected visual acuity were noted in surgeries performed by third-year residents (P=0.04). Intraocular pressure and number of medications were significantly reduced in all groups (P=0.01). Complications were registered in 60 eyes; the most frequent being the presence of a transient flat anterior chamber (27.45%). CONCLUSIONS: There were no significant differences in terms of IOP control and the number of complications in the three groups. There was no significant association between the resident's experience and the outcomes of the surgery. The Ahmed valve implant is a procedure that appears to have similar results in surgeons with different levels of training.

Prevalence of hypertensive phase and outcomes in patients with Ahmed valve implantation at one year of follow-up and evaluation of associated risk factors.

Purpose: To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk factors for both HP and failure. Methods: A cross-sectional, observational study was conducted. Medical records of patients who underwent AGV implantation and had at least 1 year of follow-up were reviewed. HP was defined as an intraocular pressure (IOP) greater than 21 mmHg between the first week and the third postoperative month not attributable to other causes. Success was defined as an IOP between 6 and 21 mmHg, with preservation of light perception and no additional glaucoma surgeries. Statistical analysis was conducted to identify possible risk factors. Results: A total of 193 eyes of 177 patients were included. HP was present in 58%; a higher preoperative IOP and younger age were associated with HP. Pseudophakic or aphakic eyes had a lower HP rate. Failure was present in 29%; neovascular glaucoma, worse basal best corrected visual acuity (BCVA), higher baseline IOP, and postoperative complications were linked to a higher likelihood of failure. No difference in the HP rate between the failure and success groups was found. Conclusion: A higher baseline IOP and younger age are associated with HP development; pseudophakia and aphakia might be protective factors. Factors for AGV failure are a worse BCVA, neovascular glaucoma, postoperative complications, and a higher baseline IOP. At 1 year, a higher number of medications were needed to achieve IOP control in the HP group.

Knowledge and awareness of glaucoma in Mexican patients with and without glaucoma diagnosis in an Ophthalmology Referral Center.

AIM: To assess and compare knowledge and awareness of glaucoma in subjects with and without glaucoma diagnosis attending an Ophthalmology Referral Center. METHODS: This cross-sectional study was conducted at Asociación Para Evitar la Ceguera in Mexico City, using a questionnaire formulated by a group of experts following the Delphi panel rules, and pre-tested in a pilot study. The questionnaire was applied and compared between: glaucoma patients, relatives of glaucoma patients and patients without glaucoma. Socio-demographic data was collected to assess correlation with the level of knowledge using Logistic regression models, estimating the odds ratios (OR), 95% confidence intervals, and P<0.05. RESULTS: Three hundred and ninety-four subjects were enrolled; with a median age of 61y. One hundred and thirty-four (34%) were patients with glaucoma, 152 (38.6%) patients without glaucoma, and 108 (27.4%) relatives of patients with glaucoma. Two hundred and ninety-one (73.9%) participants were aware of the term "glaucoma". Regarding knowledge 46.7% had moderate knowledge, 37.8% had poor knowledge, and 15.5% good knowledge. Overall, relatives of glaucoma patients had the highest scores, and patients without glaucoma got the lowest scores. A positive correlation was found between better knowledge and frequent ophthalmological examinations OR 2.24 (P=0.02), higher education level OR 4.17 (P=0.00) and having a family member with glaucoma OR 3.28 (P=0.00). CONCLUSION: Awareness and knowledge of glaucoma in subjects attending an Ophthalmology Referral Center is predominantly moderate or poor. This has important implications regarding attitudes that can result in lack of follow up in ophthalmological care.

Short-term Evaluation of Negative Pressure Applied by the Multi-Pressure Dial System to Lower Nocturnal IOP: A Prospective, Controlled, Intra-subject Study.

INTRODUCTION: The purpose of this study was to investigate the short-term safety and feasibility of negative pressure application by the Multi-Pressure Dial (MPD) System to lower nocturnal intraocular pressure (IOP) in subjects with open-angle glaucoma (OAG). METHODS: A prospective, controlled, intra-subject study of 22 eyes from 11 subjects at a single site was performed. All subjects had a history of OAG and were currently using a topical prostaglandin. For each subject, the eye with the highest IOP in the supine position was selected as the treatment eye (TE) and the contralateral eye served as the control eye (CE). The negative pressure for the TE was set to 60% of the baseline IOP value with no negative pressure in the CE. IOP measurements were collected at three prespecified time points overnight in the supine position with active negative pressure. The primary outcome measure was mean IOP with the application of negative pressure. RESULTS: At the three overnight time points, the mean (± standard deviation) baseline IOP prior to negative pressure application was 22.2 ± 2.5 mmHg in the TE and 21.8 ± 2.5 mmHg in the CE. With the application of 60% negative pressure to the TE and no active negative pressure to the CE, the mean IOP was 14.2 ± 2.2 and 19.5 ± 2.4 mmHg, respectively. The mean percentage IOP reduction in the TE was 35% (p < 0.001). There were two minor adverse events, both unrelated to device wear, and there were no IOP spikes ≥ 10 mmHg. CONCLUSION: The MPD can safely and effectively lower nocturnal IOP in the supine position. The MPD holds promise as a potential new, non-invasive treatment option for the control of nocturnal IOP.

Topical glaucoma therapy cost in Mexico.

Glaucoma is an important cause of irreversible blindness that represents a significant economic burden; most direct costs of glaucoma are drug-related. We calculated the annual cost of some of the most commonly prescribed glaucoma medications in Mexico, according to their average wholesale price (AWP) and dose regimen. Annual costs ranged from USD4.97 for Imot 15 ml (timolol 0.5 %; Laboratorios Sophia) to USD675.39 for Alphagan 5 ml (brimonidine 0.2 %; Allergan, Inc.). ß-Blockers were the least expensive glaucoma medications (range USD20.44-55.44). Alphagan 5 ml was 250 % more expensive than other selective α(2)-agonists. Of the carbonic anhydrase inhibitors, dorzolamide 2 % was less expensive than brinzolamide 1 % (USD326.91 vs. USD418.96). The annual cost for prostaglandin analogs ranged from USD235.58 for bimatoprost 0.03 % to USD337.78 for latanoprost 0.005 %. Some fixed combinations were less expensive than separate combinations. The average annual cost for all treatments increased by 27.87 ± 10.09 % between 2009 and 2012. Annual glaucoma therapy cost seems to be lower in Mexico than in other countries, due to a lower AWP, especially for some medications made by Mexican laboratories.

Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma.

PURPOSE: To describe clinical results of Ahmed glaucoma valve implantation in Mexican patients with neovascular glaucoma (NVG). MATERIALS AND METHODS: We reviewed records of 60 eyes of 60 patients with NVG who underwent Ahmed valve implantation, with a follow-up period of 1 year. We identified successful and failed cases and compared baseline and follow-up characteristics to identify possible differences between both groups. RESULTS: We classified 36 eyes (60%) as successful and 24 (40%) as failed cases. We found a significant difference in success rate in patients who had a hypertensive phase at any time during the follow-up period (OR = 5.15, CI = 1.49-20.15, p = 0.004). Patients in the success group showed a statistically significant decrease in the number of glaucoma medications 1 year after surgery (p <0.0001). We found a statistically significant difference in success rate in patients who had preoperative best corrected visual acuity (BCVA) better than logmar 0.70 (odds ratio 4.31, CI = 1.1-19.3, p = 0.03086). CONCLUSION: A hypertensive postoperative phase and a preoperative BCVA worse or equal to 20/100 seem to be risk factors for Ahmed valve surgical failure in patients with NVG. How to cite this article: Hernandez-Oteyza A, Lazcano-Gomez G, Jimenez-Roman J, Hernandez-Garciadiego C. Surgical Outcome of Ahmed Valve Implantation in Mexican Patients with Neovascular Glaucoma. J Curr Glaucoma Pract 2014;8(3):86-90.